NPI | 1376694604 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: CA 44201) |
Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: CA 44201) |
Enumeration Date | 2007-01-15 |
Last Update Date | 2007-12-03 |