NPI | 1336125913 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: CA 48778) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 48778) |
Enumeration Date | 2005-12-15 |
Last Update Date | 2013-02-13 |