| NPI | 1396925327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 56816) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN 12158) |
| Enumeration Date | 2007-11-07 |
| Last Update Date | 2022-07-21 |