| NPI | 1568607695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 62525) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 24360) |
| Enumeration Date | 2008-12-03 |
| Last Update Date | 2015-12-07 |