| NPI | 1669685277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 41264) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA AC7367) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2007-07-08 |