| NPI | 1871917872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 103656) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901021107) |
| Enumeration Date | 2014-02-11 |
| Last Update Date | 2022-02-18 |