NPI | 1457640757 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CA 58128) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 58128) |
Enumeration Date | 2011-04-07 |
Last Update Date | 2011-04-07 |