| NPI | 1861610842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CA 63463) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 21620) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2014-10-26 |