| NPI | 1306948369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 48614) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 25345) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2010-10-06 |