| NPI | 1518044411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 61065) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901019412) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2014-08-15 |