| NPI | 1225231996 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 59256) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 0524411) |
| 1223G0001X Dentist, General Practice (Licence: MA 22276) | |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2025-02-07 |