| NPI | 1336149368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 7474) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 43603) |
| Enumeration Date | 2005-08-01 |
| Last Update Date | 2018-01-08 |