| NPI | 1760611685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 55164) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 55164) |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2023-04-19 |