NPI | 1033241161 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 53822) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 53822) |
Enumeration Date | 2007-03-12 |
Last Update Date | 2014-02-25 |