NPI | 1386869063 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 38910) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 38910) |
Enumeration Date | 2007-04-16 |
Last Update Date | 2014-10-23 |