| NPI | 1467046953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: CA 106010) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 106010) |
| Enumeration Date | 2021-02-24 |
| Last Update Date | 2023-06-12 |