| NPI | 1053440156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 43021) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA BJ4608709) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2024-09-26 |