| NPI | 1972743458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 35433) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: CA 35433) |
| 1223G0001X Dentist, General Practice (Licence: NV 3783) | |
| Enumeration Date | 2009-02-24 |
| Last Update Date | 2024-05-17 |