| NPI | 1336492891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: CA 2051) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 28453) |
| 122300000X Dentist (Licence: CA 105729) | |
| 1223G0001X Dentist, General Practice (Licence: TX 28453) | |
| Enumeration Date | 2012-10-22 |
| Last Update Date | 2025-05-28 |