NPI | 1033450721 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CA 62192) |
Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NY 054765) |
Enumeration Date | 2013-03-06 |
Last Update Date | 2013-03-06 |