| NPI | 1659589109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 39165) |
| Additional Taxonomies | 124Q00000X Dental Hygienist |
| 126800000X Dental Assistant | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2007-11-02 |