| NPI | 1437759164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DDS105667) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 105667) |
| Enumeration Date | 2020-10-30 |
| Last Update Date | 2023-09-20 |