NPI | 1255737151 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA DDS101428) |
Additional Taxonomies | 122300000X Dentist (Licence: NV 6569) |
Enumeration Date | 2014-11-05 |
Last Update Date | 2017-07-12 |