NPI | 1760712269 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 43494) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 43494) |
Enumeration Date | 2010-01-05 |
Last Update Date | 2020-02-10 |