| NPI | 1952435794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 56457) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 9047) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2008-07-16 |