| NPI | 1821673468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DDS108742) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE61298996) |
| Enumeration Date | 2021-03-16 |
| Last Update Date | 2023-10-18 |