| NPI | 1962510545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 43131) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 43131) |
| 1223X2210X Dentist, Orofacial Pain (Licence: CA 43131) | |
| 125Q00000X Oral Medicinist (Licence: CA 43131) | |
| 174400000X Specialist (Licence: CA 43131) | |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2020-06-16 |