| NPI | 1508932039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 41255) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 41255) |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2016-02-09 |