| NPI | 1265002893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 106308) |
| Additional Taxonomies | 122300000X Dentist (Licence: NM DB-2025-0113) |
| Enumeration Date | 2021-06-27 |
| Last Update Date | 2026-03-22 |