| NPI | 1225496771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA DDS30334) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: CA 30334) |
| Enumeration Date | 2016-01-28 |
| Last Update Date | 2023-10-18 |