| NPI | 1407840010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NV 5080) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 48680) |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2025-05-08 |