| NPI | 1730286188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA DDS103262) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: RI DEN02680) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2021-04-21 |