| NPI | 1346772878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA Graduation 05/2017) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 102433) |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2021-02-09 |