| NPI | 1760829774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DDS107398) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D008719) |
| 1223G0001X Dentist, General Practice (Licence: IL 019030118) | |
| 1223G0001X Dentist, General Practice (Licence: TN 9920) | |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2023-08-21 |