| NPI | 1881325256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 113468) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS044323) |
| 1223G0001X Dentist, General Practice (Licence: WI 6001008-15) | |
| 1223G0001X Dentist, General Practice (Licence: WA DENT.DE.70003215) | |
| Enumeration Date | 2022-06-17 |
| Last Update Date | 2026-08-25 |