NPI | 1235533605 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CA 101731) |
Additional Taxonomies | 122300000X Dentist (Licence: TX 30401) |
Enumeration Date | 2014-10-14 |
Last Update Date | 2018-06-12 |