| NPI | 1316491731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 102998) |
| Additional Taxonomies | 122300000X Dentist (Licence: AK 00000000000) |
| Enumeration Date | 2016-08-15 |
| Last Update Date | 2021-12-13 |