| NPI | 1649729831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 103627) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 103627) |
| 122300000X Dentist (Licence: NV LL-415-16) | |
| Enumeration Date | 2016-09-28 |
| Last Update Date | 2019-06-22 |