NPI | 1508932039 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 41255) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 41255) |
Enumeration Date | 2006-11-27 |
Last Update Date | 2016-02-09 |