| NPI | 1508604166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 110322) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS044763) |
| Enumeration Date | 2024-07-17 |
| Last Update Date | 2024-07-19 |