| NPI | 1780242784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 104843) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12013187A) |
| Enumeration Date | 2019-06-04 |
| Last Update Date | 2020-04-22 |