| NPI | 1679643001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 44531) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 4553T) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2007-07-08 |