| NPI | 1609563147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NV 7846) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 112732) |
| 122300000X Dentist (Licence: CA 112732) | |
| Enumeration Date | 2023-04-24 |
| Last Update Date | 2026-05-08 |