| NPI | 1104428333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA CA105982) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 7406) |
| Enumeration Date | 2020-11-12 |
| Last Update Date | 2025-07-30 |