| NPI | 1598989063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 50765) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 50765) |
| 122300000X Dentist (Licence: CA 50765) | |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2025-10-08 |