| NPI | 1780237818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 112871) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401416552) |
| 122300000X Dentist (Licence: MI 2901601386) | |
| Enumeration Date | 2019-07-18 |
| Last Update Date | 2026-09-02 |