| NPI | 1669626511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 62932) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 62932) |
| 122300000X Dentist (Licence: NY 054219-1) | |
| Enumeration Date | 2008-11-05 |
| Last Update Date | 2021-03-05 |