| NPI | 1427543784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AK 175429) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 102648) |
| Enumeration Date | 2018-06-28 |
| Last Update Date | 2021-10-01 |