| NPI | 1265861801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 62453) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1859150) |
| Enumeration Date | 2013-11-04 |
| Last Update Date | 2024-11-27 |