| NPI | 1831343227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 50061) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA ds036831) |
| Enumeration Date | 2008-11-11 |
| Last Update Date | 2017-02-06 |