NPI | 1497156038 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: CA 63761) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 44534) |
Enumeration Date | 2014-09-15 |
Last Update Date | 2017-08-06 |