| NPI | 1144000324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DDS109871) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D011958) |
| Enumeration Date | 2023-10-04 |
| Last Update Date | 2025-04-28 |