| NPI | 1356337257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 57833) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 21203) |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2010-10-07 |