| NPI | 1346610623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: CA DDS106119) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: WA DE60536003) |
| Enumeration Date | 2015-09-30 |
| Last Update Date | 2023-07-11 |