| NPI | 1417366014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA DDS105958) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D10122) |
| Enumeration Date | 2014-08-07 |
| Last Update Date | 2021-04-30 |