| NPI | 1891806287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 49152) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2017028537) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2019-02-28 |