| NPI | 1255638896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 60920) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 7605689-9921) |
| Enumeration Date | 2011-02-17 |
| Last Update Date | 2016-10-28 |