| NPI | 1750753414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 65221) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 65221) |
| Enumeration Date | 2015-10-21 |
| Last Update Date | 2023-07-27 |