| NPI | 1982083358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 108378) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 059084) |
| Enumeration Date | 2015-05-19 |
| Last Update Date | 2025-04-23 |