NPI | 1174722300 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: CA 54457) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 54457) |
Enumeration Date | 2007-07-17 |
Last Update Date | 2009-04-15 |