| NPI | 1902890791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 51595) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AR 4033) |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2025-12-01 |