| NPI | 1538569389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NV 6549) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 63941) |
| Enumeration Date | 2014-08-29 |
| Last Update Date | 2017-09-15 |