| NPI | 1770271868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 107656) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 107656) |
| Enumeration Date | 2023-04-26 |
| Last Update Date | 2025-09-04 |