| NPI | 1497122311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 102262) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 31034) |
| Enumeration Date | 2015-08-26 |
| Last Update Date | 2022-03-24 |