| NPI | 1346498805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 5869) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 57652) |
| Enumeration Date | 2008-09-08 |
| Last Update Date | 2010-10-28 |