| NPI | 1255478418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 44943) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 44943) |
| 122300000X Dentist (Licence: CA D44943) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2020-01-27 |