| NPI | 1689818023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: HI 1946) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 30748) |
| Enumeration Date | 2009-04-29 |
| Last Update Date | 2009-04-29 |