| NPI | 1811083942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: VA 040141414133) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 50716) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2013-09-09 |