| NPI | 1316163819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 31588) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 4831T) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2012-04-27 |