| NPI | 1265091169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 17339) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 105178) |
| 1223G0001X Dentist, General Practice (Licence: NC 11464) | |
| 122300000X Dentist (Licence: DC DEN2000050) | |
| Enumeration Date | 2019-06-13 |
| Last Update Date | 2023-01-11 |