| NPI | 1669686846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TN 9184) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 54795) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2010-10-28 |