| NPI | 1275797631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 37082) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 30382) |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2021-04-02 |