| NPI | 1689752677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 34986) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 7579) |
| 122300000X Dentist (Licence: WA DE 60303875) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2013-02-13 |