| NPI | 1285083287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 6853) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 100268) |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2022-11-14 |