NPI | 1417152430 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: CA 62908) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 14099) |
122300000X Dentist (Licence: VA 0401412328) | |
Enumeration Date | 2007-06-19 |
Last Update Date | 2014-01-21 |