| NPI | 1013988971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 032896) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 028814) |
| 1223G0001X Dentist, General Practice (Licence: CA 053606) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 016290) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2007-07-08 |