| NPI | 1275572539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 25621) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 26479) |
| 1223G0001X Dentist, General Practice (Licence: CA 32632) | |
| 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: CA 18262) | |
| 1223P0300X Dentist, Periodontics (Licence: CA 46393) | |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2007-12-06 |