| NPI | 1073120135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 104782) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 35884) |
| Enumeration Date | 2020-09-23 |
| Last Update Date | 2025-12-20 |