| NPI | 1336681576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 101024) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 101024) |
| Enumeration Date | 2016-11-04 |
| Last Update Date | 2023-06-19 |