| NPI | 1043389075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: CA 53980) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 53980) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2014-01-10 |