| NPI | 1477833119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: CA 60671) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 60671) |
| Enumeration Date | 2011-08-25 |
| Last Update Date | 2019-06-28 |