| NPI | 1750497004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 71095547339682) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 39682) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2010-02-17 |