| NPI | 1467285601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 110749) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN29583) |
| Enumeration Date | 2024-08-22 |
| Last Update Date | 2024-09-10 |