| NPI | 1578975587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: CA GA 1763) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 63299) |
| Enumeration Date | 2014-05-24 |
| Last Update Date | 2015-08-25 |