| NPI | 1265153639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D11883) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 107927) |
| Enumeration Date | 2022-09-06 |
| Last Update Date | 2023-09-26 |