| NPI | 1679351159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 109088) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 8192) |
| 1223G0001X Dentist, General Practice (Licence: FL DN28665) | |
| Enumeration Date | 2023-09-18 |
| Last Update Date | 2025-10-26 |