NPI | 1609930700 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 100078) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN D12190) |
Enumeration Date | 2006-12-21 |
Last Update Date | 2019-05-09 |