| NPI | 1255741393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 100528) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 9823) |
| Enumeration Date | 2014-04-29 |
| Last Update Date | 2022-02-10 |