| NPI | 1831644053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0004X Dentist Dentist Anesthesiologist (Licence: CA D100729) |
| Additional Taxonomies | 1223D0004X Dentist Dentist Anesthesiologist (Licence: CA 100729) |
| Enumeration Date | 2016-08-17 |
| Last Update Date | 2022-03-30 |