| NPI | 1821233768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 57756) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 054098) |
| Enumeration Date | 2008-12-05 |
| Last Update Date | 2009-01-19 |