NPI | 1427159748 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: CA 54371) |
Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: VA 0401410833) |
Enumeration Date | 2006-09-26 |
Last Update Date | 2014-08-25 |