| NPI | 1306277934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 63125) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60417176) |
| Enumeration Date | 2013-12-08 |
| Last Update Date | 2013-12-12 |