| NPI | 1457371601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 51392) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN 51392) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2024-08-16 |