| NPI | 1679874341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: CA GA1658) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 62360) |
| Enumeration Date | 2010-11-10 |
| Last Update Date | 2025-12-09 |