| NPI | 1902538606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 107557) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 38565) |
| Enumeration Date | 2022-06-30 |
| Last Update Date | 2024-06-01 |