NPI | 1063626166 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CA 63386) |
Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NV 4625) |
Enumeration Date | 2007-05-09 |
Last Update Date | 2017-03-06 |