| NPI | 1679201115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 6001327-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 107748) |
| Enumeration Date | 2022-08-11 |
| Last Update Date | 2023-08-09 |