NPI | 1346409125 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: CA 40917) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 40917) |
Enumeration Date | 2008-06-05 |
Last Update Date | 2018-07-02 |