| NPI | 1447392964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA D28906) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA B28906) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2010-02-23 |