| NPI | 1831446400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 37165) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 61632) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 61632) | |
| Enumeration Date | 2012-08-13 |
| Last Update Date | 2021-12-07 |