| NPI | 1578916029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID 5233) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 100489) |
| Enumeration Date | 2016-07-20 |
| Last Update Date | 2021-05-27 |