| NPI | 1669501599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 56727) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS036548) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2008-11-10 |