| NPI | 1861851453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 104783) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401415393) |
| Enumeration Date | 2016-02-11 |
| Last Update Date | 2022-03-15 |