| NPI | 1639329337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NV 5929) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ 7848) |
| 1223G0001X Dentist, General Practice (Licence: CA 56563) | |
| Enumeration Date | 2008-09-30 |
| Last Update Date | 2014-05-28 |