| NPI | 1467978262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 101712) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA DDS101712) |
| 1223G0001X Dentist General Practice (Licence: CA DDS) | |
| Enumeration Date | 2017-08-15 |
| Last Update Date | 2017-08-15 |