| NPI | 1629325923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CA DDS61507) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 61507) |
| Enumeration Date | 2012-08-07 |
| Last Update Date | 2026-06-22 |