| NPI | 1306953229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 51507) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OR D11142) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2021-11-30 |