| NPI | 1659422194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 48020) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA AC 11429) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2011-07-15 |