| NPI | 1952324378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D9980) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 53298) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2020-12-15 |