| NPI | 1730149840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 103569) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 22541) |
| 1223D0001X Dentist, Dental Public Health (Licence: OH 21650) | |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2019-05-29 |