| NPI | 1821267964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 51856) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 17278) |
| Enumeration Date | 2008-02-22 |
| Last Update Date | 2008-04-29 |