| NPI | 1467671529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 54222) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 4874) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2014-07-30 |