| NPI | 1982133385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DDS101878) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901022200) |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2021-12-02 |