| NPI | 1427029446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 27366) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NE 5995) |
| Enumeration Date | 2006-01-28 |
| Last Update Date | 2007-07-09 |