| NPI | 1467682815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 63186) |
| Additional Taxonomies | 126800000X Dental Assistant (Licence: CA 66585) |
| 124Q00000X Dental Hygienist (Licence: FL 21303) | |
| Enumeration Date | 2009-07-20 |
| Last Update Date | 2014-02-11 |