| NPI | 1548581242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 60059) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 60673) |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2018-06-15 |