| NPI | 1679664114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 103434) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D4198) |
| 1223G0001X Dentist, General Practice (Licence: OR D5597) | |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2019-02-25 |