| NPI | 1619554276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 108552) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL 26498) |
| 122300000X Dentist (Licence: FL DN26498) | |
| Enumeration Date | 2021-03-28 |
| Last Update Date | 2023-08-09 |