| NPI | 1447942917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 111722) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 064576) |
| Enumeration Date | 2023-05-23 |
| Last Update Date | 2025-09-27 |