| NPI | 1841418738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR 9219) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 32122) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2012-11-01 |