| NPI | 1184879983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CA 59461) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NE 6741) |
| 122300000X Dentist (Licence: CA 59461) | |
| Enumeration Date | 2008-11-20 |
| Last Update Date | 2010-09-07 |