| NPI | 1790838449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 41969) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95000028) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2014-02-17 |