| NPI | 1336310309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 5606) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 57069) |
| Enumeration Date | 2008-03-18 |
| Last Update Date | 2016-06-20 |