| NPI | 1730540956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 65292) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 65292) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 65292) | |
| Enumeration Date | 2016-03-16 |
| Last Update Date | 2016-03-16 |