| NPI | 1467885822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 109107) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ 10537) |
| 1223G0001X Dentist, General Practice (Licence: OH 30-023954) | |
| Enumeration Date | 2013-08-20 |
| Last Update Date | 2023-11-15 |