| NPI | 1699345835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 107517) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 7507) |
| Enumeration Date | 2021-06-29 |
| Last Update Date | 2023-01-05 |