| NPI | 1578685236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CA 59065) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 21590) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2011-12-01 |