| NPI | 1700225752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 107259) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN014612) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: GA DN014612) | |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2022-09-22 |