NPI | 1043578180 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 65039) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401413979) |
Enumeration Date | 2012-04-26 |
Last Update Date | 2016-12-22 |