| NPI | 1316599855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA DDS108965) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: AZ D010381) |
| Enumeration Date | 2019-07-15 |
| Last Update Date | 2023-10-25 |