| NPI | 1316077498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CA 45310) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 45310) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2020-06-12 |