| NPI | 1902141963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401414407) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 61618) |
| Enumeration Date | 2012-12-03 |
| Last Update Date | 2014-04-30 |