| NPI | 1659526366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA D35153) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA DDO35153) |
| Enumeration Date | 2008-11-21 |
| Last Update Date | 2019-02-02 |