| NPI | 1548283104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 51721) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS022225L) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2016-10-24 |