| NPI | 1295408730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401417609) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 111671) |
| Enumeration Date | 2021-07-30 |
| Last Update Date | 2026-03-23 |