| NPI | 1538274998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 49598) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: FL DH16272) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2016-02-02 |