NPI | 1528400561 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA DDS100229) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 6322) |
Enumeration Date | 2013-07-18 |
Last Update Date | 2017-01-15 |