| NPI | 1649272774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 28376) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CA 28376) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2015-03-13 |