| NPI | 1760964845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D11950) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 103174) |
| Enumeration Date | 2018-09-05 |
| Last Update Date | 2024-06-21 |