NPI | 1225197734 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: CA 37519) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 37519) |
1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 37519) | |
Enumeration Date | 2006-12-08 |
Last Update Date | 2019-06-03 |