| NPI | 1952533473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CA 00558699) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 58689) |
| 1223G0001X Dentist, General Practice (Licence: CA 58689) | |
| 1223P0700X Dentist, Prosthodontics (Licence: NY 054922-1) | |
| Enumeration Date | 2009-08-17 |
| Last Update Date | 2021-08-04 |