NPI | 1053417261 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 52875) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 52875) |
Enumeration Date | 2006-09-15 |
Last Update Date | 2016-08-04 |