| NPI | 1275778342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 50607) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D7469) |
| Enumeration Date | 2008-12-03 |
| Last Update Date | 2011-02-02 |