| NPI | 1437776606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 126800000X Dental Assistant (Licence: WA D160946710) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 112429) |
| Enumeration Date | 2020-07-02 |
| Last Update Date | 2026-02-06 |