| NPI | 1730248212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 31915) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 31915) |
| 1223D0001X Dentist, Dental Public Health (Licence: CA 31915) | |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2012-10-23 |