| NPI | 1659667236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 107982) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 14955) |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2023-02-17 |