NPI | 1386900504 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: CA 64365) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 50 056784) |
Enumeration Date | 2012-04-02 |
Last Update Date | 2015-04-29 |