| NPI | 1265915508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA DDS110213) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO DEN.00203773) |
| Enumeration Date | 2018-09-12 |
| Last Update Date | 2024-10-23 |