| NPI | 1639198021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 102278) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OR D7534) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2022-09-01 |