| NPI | 1609223023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA DDS105206) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901022328) |
| Enumeration Date | 2016-05-16 |
| Last Update Date | 2023-06-08 |