NPI | 1255490629 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: CA 39402) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 38971) |
Enumeration Date | 2006-12-08 |
Last Update Date | 2022-03-01 |