| NPI | 1073804761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: CA 1723) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 60115) |
| Enumeration Date | 2011-04-28 |
| Last Update Date | 2015-01-09 |