| NPI | 1285790477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: HI 1970) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 43560) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2014-12-31 |