| NPI | 1326157413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 43765) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901602014) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2025-04-28 |