| NPI | 1063562213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 43278) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 43521) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2014-11-05 |