| NPI | 1992906242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 44147) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA CA44147) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2021-08-13 |