| NPI | 1033718978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 105251) |
| Additional Taxonomies | 122300000X Dentist (Licence: AK 165769) |
| 122300000X Dentist (Licence: OR D11702) | |
| Enumeration Date | 2020-10-21 |
| Last Update Date | 2026-02-26 |