| NPI | 1659553980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 8513) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 47392) |
| Enumeration Date | 2007-11-28 |
| Last Update Date | 2020-09-15 |