| NPI | 1215045117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 51543) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 050834-1) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2021-09-03 |