| NPI | 1376556365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 4331002) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 4331001) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2014-04-16 |