NPI | 1205081551 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: CA DDS55709) |
Additional Taxonomies | 122300000X Dentist (Licence: NY 0538081) |
Enumeration Date | 2008-11-27 |
Last Update Date | 2016-08-30 |