| NPI | 1194780007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA DDS27525) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 27525) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2021-08-24 |