| NPI | 1235484791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 102144) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: FL DN19782) |
| Enumeration Date | 2012-07-19 |
| Last Update Date | 2021-09-28 |