| NPI | 1770615858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 12103) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA DA031005) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2025-03-17 |