| NPI | 1518042647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CA 033245) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CA 033245) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2014-10-28 |