| NPI | 1518526821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 106511) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 24265) |
| Enumeration Date | 2019-06-10 |
| Last Update Date | 2022-02-24 |