| NPI | 1356933063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA DDS103842) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA DDS103842) |
| Enumeration Date | 2021-02-04 |
| Last Update Date | 2022-04-07 |