NPI | 1497741672 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 59069) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2004017842) |
122300000X Dentist (Licence: CA 59069) | |
Enumeration Date | 2005-09-23 |
Last Update Date | 2010-01-28 |