| NPI | 1265558332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA D21984) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2022-07-21 |