| NPI | 1780856849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GU D1009) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 56525) |
| 1223G0001X Dentist, General Practice (Licence: UT 66512788903) | |
| Enumeration Date | 2008-03-29 |
| Last Update Date | 2013-04-25 |