| NPI | 1184852691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 59690) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901020053) |
| Enumeration Date | 2009-06-24 |
| Last Update Date | 2016-06-13 |