| NPI | 1205081551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DDS55709) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 0538081) |
| Enumeration Date | 2008-11-27 |
| Last Update Date | 2016-08-30 |