| NPI | 1306940093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: IA 40077) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: CA 49545) |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2007-07-08 |