| NPI | 1497741672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 59069) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2004017842) |
| 122300000X Dentist (Licence: CA 59069) | |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2010-01-28 |