| NPI | 1285653378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 40386) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 29435) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2014-06-04 |