| NPI | 1972638393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA D7785960) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA D7785960) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2007-07-08 |