| NPI | 1518309145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA DDS103299) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN 20293) |
| Enumeration Date | 2013-07-24 |
| Last Update Date | 2018-12-18 |