| NPI | 1780673202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 31914) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 31914) |
| 1223X2210X Dentist, Orofacial Pain (Licence: CA 31914) | |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2021-09-21 |