| NPI | 1740883032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DDS105537) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 00205510) |
| 1223G0001X Dentist, General Practice (Licence: CA DDS105537) | |
| Enumeration Date | 2020-11-18 |
| Last Update Date | 2023-03-27 |