| NPI | 1629215660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 103408) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 57921) |
| 1223G0001X Dentist, General Practice (Licence: IL 019.028934) | |
| Enumeration Date | 2009-01-13 |
| Last Update Date | 2019-07-26 |