| NPI | 1366708166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 62670) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NY 056658) |
| Enumeration Date | 2012-04-05 |
| Last Update Date | 2021-04-19 |