| NPI | 1265156970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CA 46453) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: AZ D011741) |
| Enumeration Date | 2022-09-27 |
| Last Update Date | 2023-05-01 |