NPI | 1477905248 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA dds100037) |
Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CA DDS100037) |
Enumeration Date | 2016-07-06 |
Last Update Date | 2019-06-17 |