| NPI | 1871982140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA DDS108583) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CO DEN.00202413) |
| Enumeration Date | 2015-01-09 |
| Last Update Date | 2023-04-03 |