| NPI | 1295961829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 58325) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NV S1-136) |
| Enumeration Date | 2009-06-10 |
| Last Update Date | 2016-04-20 |