| NPI | 1447311725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 20995) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: CA 20995) |
| 1223P0300X Dentist Periodontics (Licence: CA 20995) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2019-09-18 |