| NPI | 1770133944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 104540) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D11157) |
| Enumeration Date | 2019-09-18 |
| Last Update Date | 2024-06-10 |