NPI | 1730312836 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 58487) |
Additional Taxonomies | 122300000X Dentist (Licence: TX 27221) |
Enumeration Date | 2009-08-24 |
Last Update Date | 2013-06-12 |