| NPI | 1720118920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 47536) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: CA 47536) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2026-04-06 |