| NPI | 1518004944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 60649) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AR 3505) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2018-12-18 |