| NPI | 1215098447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: VA 0401414064) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 54674) |
| 122300000X Dentist (Licence: VA 0401414064) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2025-09-07 |