| NPI | 1750414629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 58355) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MA 20551) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2018-03-17 |