| NPI | 1457505869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NC 9186) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 1223P0700X Dentist, Prosthodontics (Licence: CA 58926) | |
| Enumeration Date | 2008-11-12 |
| Last Update Date | 2025-08-12 |