| NPI | 1275547580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 63905) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 009854) |
| Enumeration Date | 2006-07-29 |
| Last Update Date | 2017-01-26 |