| NPI | 1457041162 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 110277) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 110277) |
| Enumeration Date | 2023-05-08 |
| Last Update Date | 2024-12-23 |