| NPI | 1477280881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 107716) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN31426) |
| Enumeration Date | 2022-08-04 |
| Last Update Date | 2026-04-01 |