| NPI | 1235324880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 56333) |
| Additional Taxonomies | 122300000X Dentist (Licence: NV 5568) |
| Enumeration Date | 2007-09-06 |
| Last Update Date | 2024-06-23 |