| NPI | 1710723523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 112489) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 12545) |
| Enumeration Date | 2024-07-02 |
| Last Update Date | 2026-03-12 |