| NPI | 1073525622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 35324) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 9356) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2008-07-15 |