NPI | 1659680619 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 60709) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 60709) |
Enumeration Date | 2010-09-24 |
Last Update Date | 2012-02-21 |