NPI | 1649509761 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 15424) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 15424) |
Enumeration Date | 2009-12-19 |
Last Update Date | 2009-12-19 |