| NPI | 1578854303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 24639) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 24639) |
| 1223E0200X Dentist, Endodontics (Licence: CA 24639) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 24639) | |
| 1223P0700X Dentist, Prosthodontics (Licence: CA 24639) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 24639) | |
| Enumeration Date | 2011-04-27 |
| Last Update Date | 2011-04-27 |