| NPI | 1881203974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 107056) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2020022423) |
| 1223G0001X Dentist, General Practice (Licence: KS 61723) | |
| Enumeration Date | 2020-07-24 |
| Last Update Date | 2024-03-06 |