NPI | 1447311725 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 20995) |
Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: CA 20995) |
1223P0300X Dentist, Periodontics (Licence: CA 20995) | |
Enumeration Date | 2006-12-12 |
Last Update Date | 2019-09-18 |