| NPI | 1841554847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 61208) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 6280) |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2014-02-24 |