| NPI | 1336764562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 110064) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 81777) |
| Enumeration Date | 2020-06-12 |
| Last Update Date | 2024-05-10 |