| NPI | 1629357843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 60962) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 60962) |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2023-06-27 |