| NPI | 1396195566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 102341) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 6825) |
| Enumeration Date | 2016-06-17 |
| Last Update Date | 2022-07-18 |