| NPI | 1457576118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OR D8593) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 56130) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2008-06-13 |