| NPI | 1780805671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 22065) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA 22065) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2007-07-08 |