| NPI | 1053458620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 12042863) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 42120) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2026-02-04 |