| NPI | 1538541701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 101138) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD4316) |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2024-08-19 |