| NPI | 1326574203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: OR D12261) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: CA 105703) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2025-09-08 |