NPI | 1487617676 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: CA 27821) |
Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 27821) |
Enumeration Date | 2006-04-09 |
Last Update Date | 2012-10-01 |