NPI | 1154581403 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 56503) |
Additional Taxonomies | 122300000X Dentist (Licence: CT 009864) |
Enumeration Date | 2008-06-10 |
Last Update Date | 2010-09-24 |