| NPI | 1982796975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 50355) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 058395-1) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2023-06-27 |