| NPI | 1528391182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: HI DT1848) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA DDS38942) |
| Enumeration Date | 2009-09-15 |
| Last Update Date | 2023-04-19 |