| NPI | 1437299922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA dds109929) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 0517781) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2024-06-20 |