| NPI | 1538170758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA B35271) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 35271) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2007-08-22 |