| NPI | 1841587425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 5735) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 57908) |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2011-07-05 |