| NPI | 1649161696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 111950) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 14298811-9926) |
| Enumeration Date | 2025-07-09 |
| Last Update Date | 2026-07-16 |