| NPI | 1679634190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA DDS108853) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR 8843) |
| 1223G0001X Dentist, General Practice (Licence: OR D8843) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2024-03-21 |