| NPI | 1881248730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA DDS104066) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 104066) |
| Enumeration Date | 2019-07-30 |
| Last Update Date | 2022-02-07 |