| NPI | 1144473588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CA 111264) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 57850) |
| Enumeration Date | 2008-10-29 |
| Last Update Date | 2025-10-21 |