| NPI | 1750952800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 112126) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 11756) |
| Enumeration Date | 2021-07-08 |
| Last Update Date | 2026-02-14 |