| NPI | 1730301045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA CA035331) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901014460) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2007-07-08 |