| NPI | 1225056856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 53502) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA BW9064611) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2012-01-19 |