| NPI | 1649568569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 27576) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: HI 1109) |
| Enumeration Date | 2011-07-12 |
| Last Update Date | 2021-05-27 |