| NPI | 1083047898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA C26288) |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: CA C26288) |
| Enumeration Date | 2013-08-15 |
| Last Update Date | 2013-08-15 |