NPI | 1790906105 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: CA 49587) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 49587) |
Enumeration Date | 2007-05-01 |
Last Update Date | 2007-07-08 |