| NPI | 1528259678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 56532) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D7334) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2009-01-15 |