| NPI | 1801916945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 48995) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 51466) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2007-07-08 |