| NPI | 1861567349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 45130) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 4897T) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2015-08-06 |