| NPI | 1235533605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CA 101731) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 30401) |
| Enumeration Date | 2014-10-14 |
| Last Update Date | 2018-06-12 |