| NPI | 1740433614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 57522) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 5746) |
| Enumeration Date | 2008-10-23 |
| Last Update Date | 2013-12-05 |