| NPI | 1225606072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS043185) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA DDS106996) |
| Enumeration Date | 2021-06-16 |
| Last Update Date | 2022-05-08 |