| NPI | 1427101583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 64002) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 053050) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2015-03-16 |