NPI | 1073813218 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 62400) |
Additional Taxonomies | 122300000X Dentist (Licence: NV 6082) |
Enumeration Date | 2010-10-21 |
Last Update Date | 2014-11-29 |