| NPI | 1457640757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: CA 58128) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 58128) |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2011-04-07 |