| NPI | 1265105605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 106757) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GU D1048) |
| Enumeration Date | 2021-07-30 |
| Last Update Date | 2025-05-31 |