| NPI | 1770502874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 41740) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA 11557) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2015-12-27 |