| NPI | 1528794302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D012763) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA DDS108908) |
| 1223G0001X Dentist, General Practice (Licence: NE 7860) | |
| Enumeration Date | 2022-07-25 |
| Last Update Date | 2026-09-08 |