| NPI | 1629152251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 50079) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 045534) |
| 1223G0001X Dentist, General Practice (Licence: NV 4844T) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2022-02-03 |