| NPI | 1578629283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 57926) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 5945) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2009-03-04 |