| NPI | 1275217887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 111391) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN D14913) |
| Enumeration Date | 2023-06-14 |
| Last Update Date | 2025-06-15 |