| NPI | 1023487758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 65109) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: CA 65109) |
| 1223G0001X Dentist, General Practice (Licence: CA 65109) | |
| Enumeration Date | 2015-09-23 |
| Last Update Date | 2015-09-23 |