| NPI | 1992708903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 51729) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901016069) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2015-05-11 |