| NPI | 1659594000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 30187) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 44422) |
| 122300000X Dentist (Licence: CA 51233) | |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2007-07-08 |