| NPI | 1891911459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CA 34017) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: CA DM034017) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2016-06-22 |