| NPI | 1609918101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 64667) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 19967) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2016-09-01 |