| NPI | 1033476148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DDS103582) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS038948) |
| 1223G0001X Dentist, General Practice (Licence: CA DDS103582) | |
| Enumeration Date | 2012-04-13 |
| Last Update Date | 2024-09-07 |