| NPI | 1992367262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 107066) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 11353602-9921) |
| Enumeration Date | 2019-07-08 |
| Last Update Date | 2023-02-06 |