| NPI | 1508451485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 105728) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL 25634) |
| 122300000X Dentist (Licence: SC 8727) | |
| Enumeration Date | 2021-03-03 |
| Last Update Date | 2022-09-19 |