| NPI | 1659054963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 109035) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 10-9035) |
| Enumeration Date | 2023-08-11 |
| Last Update Date | 2023-08-11 |