| NPI | 1174043764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 101448) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 101448) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NV 7041) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NV S3-356) | |
| Enumeration Date | 2017-06-23 |
| Last Update Date | 2022-09-13 |