| NPI | 1154309250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 48075) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NY 048487) |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2025-06-06 |