| NPI | 1447351127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 57774) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 053222) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2020-08-22 |