| NPI | 1518184647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 54818) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: CA 54818) |
| 1223P0700X Dentist, Prosthodontics (Licence: CA 54818) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 54818) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 54818) | |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2018-03-07 |