| NPI | 1720313018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2018025504) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 62775) |
| Enumeration Date | 2009-10-05 |
| Last Update Date | 2025-03-12 |