| NPI | 1336132984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 34691) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401 006200) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2020-03-13 |