| NPI | 1801892476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 51431) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 10161) |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2017-03-21 |