| NPI | 1730519489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 63196) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD4017) |
| Enumeration Date | 2013-11-16 |
| Last Update Date | 2020-12-03 |