| NPI | 1376977702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 62136) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 8513664-9922) |
| 1223G0001X Dentist, General Practice (Licence: UT 8513664-8903) | |
| Enumeration Date | 2013-08-21 |
| Last Update Date | 2013-08-21 |