| NPI | 1710908660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 43789) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 3207) |
| Enumeration Date | 2006-07-23 |
| Last Update Date | 2009-11-19 |