| NPI | 1043386105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 55320) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 5114) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2007-07-08 |