| NPI | 1891167268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 7766) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 64828) |
| Enumeration Date | 2015-10-26 |
| Last Update Date | 2023-02-16 |