| NPI | 1487868592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 28812) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 28812) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2012-06-05 |