| NPI | 1336791524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 103905) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 7307) |
| Enumeration Date | 2019-07-09 |
| Last Update Date | 2021-09-01 |