| NPI | 1255868436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 103568) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 060124) |
| Enumeration Date | 2017-05-18 |
| Last Update Date | 2022-07-18 |