| NPI | 1194964411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 58336) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 7089890-9922) |
| Enumeration Date | 2009-02-10 |
| Last Update Date | 2014-05-05 |