| NPI | 1811297393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 56418) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D-4338) |
| Enumeration Date | 2010-10-29 |
| Last Update Date | 2010-10-29 |