| NPI | 1750455689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 61241) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE00009083) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2023-01-23 |