| NPI | 1891801007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 32633) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: HI 1570) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2007-07-08 |