| NPI | 1467709642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 102154) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12011818A) |
| 1223G0001X Dentist, General Practice (Licence: CA 102154) | |
| Enumeration Date | 2012-08-07 |
| Last Update Date | 2023-11-26 |