| NPI | 1619677994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 112994) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DL100855) |
| Enumeration Date | 2023-03-06 |
| Last Update Date | 2026-06-25 |