| NPI | 1336464353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 58874) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 7948) |
| Enumeration Date | 2010-04-01 |
| Last Update Date | 2013-06-12 |