| NPI | 1235263278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: CA 58890) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: CA 58890) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2011-07-26 |