| NPI | 1871742965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA DDS57534) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA DN 57534) |
| Enumeration Date | 2008-09-12 |
| Last Update Date | 2022-03-31 |