| NPI | 1346227303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 5489) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 55794) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2008-02-25 |