| NPI | 1609670264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 8105) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 112759) |
| Enumeration Date | 2025-04-02 |
| Last Update Date | 2026-08-13 |