| NPI | 1801202023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: CA 63570) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 63570) |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2025-09-02 |