| NPI | 1417487513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: CA 106157) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: WV 4269) |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2022-06-28 |