| NPI | 1700856515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 52796) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 4980) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2022-07-21 |