| NPI | 1770700098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 45156) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 45156) |
| 261QD0000X Clinic/Center Dental (Licence: CA 45156) | |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2021-12-23 |