| NPI | 1427159748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 54371) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: VA 0401410833) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2014-08-25 |