NPI | 1548525785 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 61419) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 61419) |
Enumeration Date | 2012-07-12 |
Last Update Date | 2019-08-19 |