| NPI | 1659591055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: CA 52061) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 52061) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2013-09-05 |