| NPI | 1770623969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: MI 2901022115) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA D1036395) |
| 122300000X Dentist (Licence: CA 36395) | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2023-09-11 |