| NPI | 1285693168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 53470) |
| Additional Taxonomies | 122300000X Dentist (Licence: ME 3750) |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2015-12-02 |