| NPI | 1437348034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 57025) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 23415) |
| Enumeration Date | 2007-10-18 |
| Last Update Date | 2013-07-16 |