| NPI | 1902458086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA DDS108648) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ d010431) |
| Enumeration Date | 2019-07-10 |
| Last Update Date | 2024-01-15 |