| NPI | 1194451963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA DDS108317) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D011531) |
| Enumeration Date | 2022-07-25 |
| Last Update Date | 2022-11-22 |