| NPI | 1043370414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 63228) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN D12085) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2014-10-07 |