NPI | 1831334929 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: CA 1498) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 56144) |
Enumeration Date | 2008-12-04 |
Last Update Date | 2019-06-25 |