NPI | 1699866210 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: CA 51715) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 51715) |
Enumeration Date | 2006-09-27 |
Last Update Date | 2007-07-08 |