| NPI | 1508095746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 62967) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401412544) |
| Enumeration Date | 2009-07-09 |
| Last Update Date | 2014-01-16 |