| NPI | 1669893731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 64977) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA dn1855466) |
| Enumeration Date | 2013-12-17 |
| Last Update Date | 2023-05-17 |