| NPI | 1952460875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 8793) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 55148) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2015-06-03 |