| NPI | 1407139553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 8058592-9922) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 60590) |
| Enumeration Date | 2011-09-26 |
| Last Update Date | 2011-11-18 |