NPI | 1275778342 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 50607) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D7469) |
Enumeration Date | 2008-12-03 |
Last Update Date | 2011-02-02 |