| NPI | 1376649616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 18650) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 51686) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2008-01-22 |