| NPI | 1649318742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 56058) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS036838) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2010-03-17 |