| NPI | 1760568729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 55641) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 22021) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2016-10-27 |