NPI | 1790839629 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 57041) |
Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MN D12354) |
Enumeration Date | 2007-01-22 |
Last Update Date | 2011-08-11 |