| NPI | 1750551297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NC 6248) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: CA 29390) |
| Enumeration Date | 2008-03-11 |
| Last Update Date | 2020-01-07 |