| NPI | 1750552980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 35185) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE00009259) |
| Enumeration Date | 2008-03-15 |
| Last Update Date | 2008-03-15 |