| NPI | 1679695118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2008014527) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 33623) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2009-01-23 |