| NPI | 1265905186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 16191) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 58188) |
| Enumeration Date | 2019-01-03 |
| Last Update Date | 2019-01-03 |