NPI | 1821161001 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 60083) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE00010581) |
Enumeration Date | 2006-11-16 |
Last Update Date | 2013-06-28 |