| NPI | 1366584146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 49825) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: CA 49825) |
| 1223G0001X Dentist, General Practice (Licence: CA 49825) | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2021-06-01 |