| NPI | 1942515952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 65071) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD3313) |
| Enumeration Date | 2010-08-13 |
| Last Update Date | 2016-09-20 |