| NPI | 1669624391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 57329) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA DDS57329) |
| Enumeration Date | 2008-10-13 |
| Last Update Date | 2012-02-08 |