| NPI | 1457684623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 58754) |
| Additional Taxonomies | 1223X2210X Dentist, Orofacial Pain (Licence: CA 58754) |
| Enumeration Date | 2009-09-04 |
| Last Update Date | 2023-10-16 |