NPI | 1124241575 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 48376) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 48376) |
Enumeration Date | 2007-04-11 |
Last Update Date | 2020-11-20 |