| NPI | 1700030384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: CA 58779) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 58779) |
| Enumeration Date | 2008-11-10 |
| Last Update Date | 2018-10-19 |