| NPI | 1215237730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 59839) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 59239) |
| Enumeration Date | 2010-11-01 |
| Last Update Date | 2022-01-03 |