| NPI | 1992888242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 7350) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 35919) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2023-08-14 |