| NPI | 1295167914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 11488552-9921) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 62583) |
| Enumeration Date | 2013-08-05 |
| Last Update Date | 2024-09-11 |