| NPI | 1194924308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA DDS27520) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 27520) |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2024-01-17 |