| NPI | 1063626166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CA 63386) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NV 4625) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2017-03-06 |