| NPI | 1629639273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA DDS106377) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1858456) |
| Enumeration Date | 2019-06-25 |
| Last Update Date | 2021-12-15 |