| NPI | 1538216536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 57103) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12010674) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2010-01-21 |