| NPI | 1801462403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 108261) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 37225) |
| Enumeration Date | 2021-06-03 |
| Last Update Date | 2025-10-06 |