NPI | 1548581242 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 60059) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 60673) |
Enumeration Date | 2010-06-16 |
Last Update Date | 2018-06-15 |