| NPI | 1659263952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 112067) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 10018462) |
| Enumeration Date | 2025-07-19 |
| Last Update Date | 2025-08-05 |