| NPI | 1538654504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA DDS107972) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO DEN.00203637) |
| Enumeration Date | 2018-06-22 |
| Last Update Date | 2023-12-18 |