| NPI | 1548938749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D11590) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA DDS106391) |
| Enumeration Date | 2021-09-01 |
| Last Update Date | 2024-09-13 |