| NPI | 1982613170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 4497) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 49785) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2007-07-08 |