NPI | 1326226440 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 56535) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 56535) |
Enumeration Date | 2008-01-31 |
Last Update Date | 2018-11-13 |