| NPI | 1699308130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D11412) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA DDS104720) |
| Enumeration Date | 2020-02-12 |
| Last Update Date | 2022-12-13 |