| NPI | 1629685185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 107676) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D-5209) |
| Enumeration Date | 2020-09-29 |
| Last Update Date | 2025-01-15 |