| NPI | 1780093203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 64398) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2014024597) |
| Enumeration Date | 2014-08-08 |
| Last Update Date | 2016-05-27 |