| NPI | 1740273572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 51179) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 3876) |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2009-01-30 |