| NPI | 1639575855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA DDS-10255) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 63908) |
| 1223G0001X Dentist, General Practice (Licence: MN D14139) | |
| Enumeration Date | 2014-11-16 |
| Last Update Date | 2024-10-24 |