| NPI | 1003822321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: HI 1655) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 36813) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2007-07-08 |