| NPI | 1710400858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 106229) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 6937) |
| Enumeration Date | 2017-07-20 |
| Last Update Date | 2022-05-17 |