| NPI | 1760765119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 62018) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 27342) |
| Enumeration Date | 2011-09-22 |
| Last Update Date | 2024-07-19 |