| NPI | 1720492184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 106062) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 011496) |
| 122300000X Dentist (Licence: NV 6883) | |
| 1223G0001X Dentist, General Practice (Licence: FL DN 20702) | |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2021-05-26 |