| NPI | 1750403341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D-4989) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 34032) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2021-03-18 |