| NPI | 1437463882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 62131) |
| Additional Taxonomies | 122300000X Dentist (Licence: NM DD3355) |
| Enumeration Date | 2010-07-27 |
| Last Update Date | 2022-11-02 |