| NPI | 1669157665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DDS110727) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE61460415) |
| Enumeration Date | 2023-06-16 |
| Last Update Date | 2024-12-14 |