| NPI | 1538903299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA DDS112361) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D012222) |
| Enumeration Date | 2024-06-19 |
| Last Update Date | 2025-11-24 |