| NPI | 1295110716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 7604) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 64772) |
| Enumeration Date | 2015-07-27 |
| Last Update Date | 2025-01-22 |