| NPI | 1932181674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 9257847-9921) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 34706) |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2023-06-30 |