NPI | 1386768331 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 37299) |
Additional Taxonomies | 122300000X Dentist (Licence: AZ 7209) |
Enumeration Date | 2007-03-16 |
Last Update Date | 2007-07-08 |