| NPI | 1104134352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 62276) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 055233) |
| Enumeration Date | 2010-09-22 |
| Last Update Date | 2013-05-15 |