| NPI | 1689353724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 110086) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WY 1652) |
| 122300000X Dentist (Licence: CA 110086) | |
| Enumeration Date | 2023-07-17 |
| Last Update Date | 2024-08-14 |