NPI | 1023249299 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 64394) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 64394) |
Enumeration Date | 2009-08-05 |
Last Update Date | 2015-06-18 |