| NPI | 1366642076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CT 009753) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 58559) |
| Enumeration Date | 2007-07-20 |
| Last Update Date | 2010-06-29 |