NPI | 1558671065 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 59695) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 59695) |
Enumeration Date | 2010-10-18 |
Last Update Date | 2012-07-02 |