| NPI | 1710027057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 47009) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 46227) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2007-07-09 |