| NPI | 1588140461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 103361) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 7107) |
| Enumeration Date | 2018-07-13 |
| Last Update Date | 2024-03-27 |