| NPI | 1316911662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 58187) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN 11891) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2019-04-22 |