| NPI | 1982278115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401418018) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 60966563) |
| Enumeration Date | 2021-05-13 |
| Last Update Date | 2022-10-26 |