| NPI | 1528400561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA DDS100229) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 6322) |
| Enumeration Date | 2013-07-18 |
| Last Update Date | 2017-01-15 |