| NPI | 1801577416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 110555) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 8082) |
| Enumeration Date | 2023-07-26 |
| Last Update Date | 2024-09-03 |