NPI | 1548283104 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: CA 51721) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS022225L) |
Enumeration Date | 2006-07-25 |
Last Update Date | 2016-10-24 |