| NPI | 1235267980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 58950) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN D12346) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2019-12-22 |