| NPI | 1225641863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DDS105983) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 11901026-9921) |
| Enumeration Date | 2020-08-24 |
| Last Update Date | 2025-06-17 |