| NPI | 1629216726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 57817) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 57817) |
| 1223G0001X Dentist, General Practice (Licence: CA DDS57817) | |
| Enumeration Date | 2009-01-27 |
| Last Update Date | 2023-06-21 |