| NPI | 1003092024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 111402) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 45595) |
| Enumeration Date | 2008-01-21 |
| Last Update Date | 2025-06-04 |