NPI | 1124392766 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: CA 25165) |
Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: CA 25165) |
Enumeration Date | 2012-02-29 |
Last Update Date | 2012-02-29 |