| NPI | 1861640302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CA 59489) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401412149) |
| 1223P0700X Dentist, Prosthodontics (Licence: TX 25978) | |
| Enumeration Date | 2008-09-08 |
| Last Update Date | 2011-09-11 |