| NPI | 1659323269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 51139) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 51089) |
| 122300000X Dentist (Licence: CA 52632) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2012-12-06 |