| NPI | 1659950087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 110090) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2022022932) |
| Enumeration Date | 2021-04-04 |
| Last Update Date | 2025-08-07 |