| NPI | 1528280252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CA 43668) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: CA 43668) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2022-02-28 |