| NPI | 1427151547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 36938) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA DDS36968) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2013-08-23 |