| NPI | 1558917765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NV 7912) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 104081) |
| Enumeration Date | 2019-08-13 |
| Last Update Date | 2026-03-13 |