| NPI | 1962823286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 62982) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: CA 62982) |
| Enumeration Date | 2014-01-05 |
| Last Update Date | 2023-11-03 |