| NPI | 1376694604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 44201) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: CA 44201) |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2007-12-03 |