| NPI | 1235213992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 56682) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 21660) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2026-02-08 |