| NPI | 1225262371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 63587) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 22262) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NV 6142) | |
| Enumeration Date | 2009-05-04 |
| Last Update Date | 2022-10-24 |