| NPI | 1205310182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 102944) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 34601) |
| Enumeration Date | 2018-09-18 |
| Last Update Date | 2021-04-30 |