| NPI | 1760704407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 57748) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 15526) |
| Enumeration Date | 2010-02-23 |
| Last Update Date | 2010-02-23 |