| NPI | 1760799761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 64395) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 9152) |
| Enumeration Date | 2010-09-12 |
| Last Update Date | 2017-05-10 |