NPI | 1235263278 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 58890) |
Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: CA 58890) |
Enumeration Date | 2007-03-14 |
Last Update Date | 2011-07-26 |