| NPI | 1932267390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 109702) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 19621) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2025-12-23 |