| NPI | 1881329639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DD5669) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 108913) |
| Enumeration Date | 2022-07-17 |
| Last Update Date | 2024-09-29 |