| NPI | 1841776150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D010480) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA DDS102809) |
| Enumeration Date | 2018-07-19 |
| Last Update Date | 2023-07-18 |