| NPI | 1912427766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 105850) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 1001615) |
| 122300000X Dentist (Licence: NC 11217) | |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2020-12-10 |