| NPI | 1952820607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DDS105742) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA 60745075) |
| Enumeration Date | 2017-09-13 |
| Last Update Date | 2022-11-23 |