| NPI | 1699831743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 24753) |
| Additional Taxonomies | 1223P0106X Dentist Oral and Maxillofacial Pathology (Licence: CA 24753) |
| Enumeration Date | 2006-12-30 |
| Last Update Date | 2007-07-08 |