| NPI | 1811053804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 31104) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA b3110401) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2021-03-03 |