| NPI | 1700496387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 108238) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D11277) |
| Enumeration Date | 2020-08-07 |
| Last Update Date | 2023-11-09 |