| NPI | 1700949518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CA 61337) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MS 2516-89) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2021-11-12 |