| NPI | 1326517830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 108836) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 11052110-9921) |
| 1223G0001X Dentist, General Practice (Licence: WA DE61285675) | |
| Enumeration Date | 2018-11-14 |
| Last Update Date | 2023-06-17 |