| NPI | 1144637661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist Dental Public Health (Licence: CA 63666) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 63666) |
| 1223G0001X Dentist General Practice (Licence: CA 63666) | |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2014-07-16 |