| NPI | 1881388924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DDS111399) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 7765) |
| Enumeration Date | 2023-06-02 |
| Last Update Date | 2025-05-02 |