| NPI | 1700298213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 63783) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: PA DS039595) |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2015-02-20 |