| NPI | 1538906888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA DDS111011) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D012265) |
| Enumeration Date | 2024-07-12 |
| Last Update Date | 2025-01-16 |