| NPI | 1003951864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 23523) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 13691) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2009-10-06 |