| NPI | 1467860247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 63944) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 6520) |
| Enumeration Date | 2014-07-24 |
| Last Update Date | 2021-04-19 |