| NPI | 1245886894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: LA 7748) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 104283) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: NV S6-238C) | |
| Enumeration Date | 2019-08-09 |
| Last Update Date | 2026-01-09 |