| NPI | 1023267408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 57392) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2008024051) |
| Enumeration Date | 2008-09-10 |
| Last Update Date | 2016-09-12 |