| NPI | 1053797456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DDS103209) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: PA DS040485) |
| Enumeration Date | 2015-08-07 |
| Last Update Date | 2025-03-26 |