| NPI | 1518983931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 50409) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 50409) |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2023-01-24 |