| NPI | 1689921025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 61610) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: CA 61610) |
| 1223E0200X Dentist, Endodontics (Licence: CA 61610) | |
| 1223G0001X Dentist, General Practice (Licence: CA 61610) | |
| 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: CA 61610) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 61610) | |
| 1223P0300X Dentist, Periodontics (Licence: CA 61610) | |
| 1223P0700X Dentist, Prosthodontics (Licence: CA 61610) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 61610) | |
| 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: CA 61610) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 61610) | |
| Enumeration Date | 2012-08-03 |
| Last Update Date | 2012-08-14 |