| NPI | 1568793024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 59082) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D9990) |
| Enumeration Date | 2010-01-23 |
| Last Update Date | 2015-05-08 |