| NPI | 1972798601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 58197) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN D12479) |
| Enumeration Date | 2007-09-06 |
| Last Update Date | 2025-12-08 |