NPI | 1336684091 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 101108) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 101108) |
Enumeration Date | 2017-01-04 |
Last Update Date | 2018-11-12 |