| NPI | 1487864856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401411474) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 57821) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2009-12-03 |