| NPI | 1942422027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ 6615) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 47923) |
| 1223P0700X Dentist, Prosthodontics (Licence: CA 47923) | |
| 1223P0700X Dentist, Prosthodontics (Licence: AZ 6615) | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2019-02-15 |