| NPI | 1851536890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN 12635) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 22801) |
| 122300000X Dentist (Licence: WI 6348) | |
| Enumeration Date | 2008-12-04 |
| Last Update Date | 2009-04-07 |