| NPI | 1235808775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DDS106536) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 106536) |
| Enumeration Date | 2021-09-08 |
| Last Update Date | 2024-10-16 |