| NPI | 1659680619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 60709) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 60709) |
| Enumeration Date | 2010-09-24 |
| Last Update Date | 2012-02-21 |