| NPI | 1942421409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 60274) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 052473) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2025-09-18 |