| NPI | 1952442089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 54825) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 5137) |
| Enumeration Date | 2007-02-10 |
| Last Update Date | 2013-09-09 |