| NPI | 1265436257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 57830) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 051562) |
| Enumeration Date | 2005-06-08 |
| Last Update Date | 2009-02-02 |