| NPI | 1023191566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DS30922) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 30922) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2009-02-10 |