| NPI | 1093840217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2500113177) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 54630) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2025-11-26 |