| NPI | 1710675285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 108915) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN10000720) |
| Enumeration Date | 2023-04-24 |
| Last Update Date | 2025-09-29 |