NPI | 1700949518 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CA 61337) |
Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MS 2516-89) |
Enumeration Date | 2006-12-19 |
Last Update Date | 2021-11-12 |