NPI | 1255433553 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 43035) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 43035) |
Enumeration Date | 2006-09-05 |
Last Update Date | 2012-03-01 |