| NPI | 1720716350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DDS109764) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN122699) |
| Enumeration Date | 2022-08-11 |
| Last Update Date | 2024-05-24 |