| NPI | 1427035807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA DJ 29156) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401411160) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2012-06-13 |