NPI | 1205031119 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: CA 48272) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 48272) |
Enumeration Date | 2007-06-19 |
Last Update Date | 2022-04-21 |