NPI | 1437445103 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 61351) |
Additional Taxonomies | 122300000X Dentist (Licence: WA DR60225674) |
Enumeration Date | 2011-06-21 |
Last Update Date | 2012-10-05 |