| NPI | 1477672533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D-5228) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 47744) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2025-04-29 |