| NPI | 1750421830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 37607) |
| Additional Taxonomies | 122300000X Dentist (Licence: NE 5674) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2010-12-02 |