| NPI | 1457891384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA DDS107190) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 35658) |
| Enumeration Date | 2017-02-25 |
| Last Update Date | 2022-08-10 |