| NPI | 1861083396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 105907) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2023000828) |
| Enumeration Date | 2021-01-27 |
| Last Update Date | 2023-04-04 |