| NPI | 1821094160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 57885) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE00009781) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2017-03-23 |