| NPI | 1043543051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 62956) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 054614-1) |
| Enumeration Date | 2009-09-09 |
| Last Update Date | 2016-10-25 |