NPI | 1336124122 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 57127) |
Additional Taxonomies | 122300000X Dentist (Licence: MI 2901019110) |
Enumeration Date | 2005-12-14 |
Last Update Date | 2009-11-30 |