| NPI | 1568908481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DDS101988) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1857478) |
| Enumeration Date | 2017-01-17 |
| Last Update Date | 2021-01-05 |