| NPI | 1467894493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 14079) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1856271) |
| 122300000X Dentist (Licence: CA 101896) | |
| Enumeration Date | 2013-07-18 |
| Last Update Date | 2025-12-17 |