NPI | 1851695639 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: CA 36406) |
Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 36406) |
Enumeration Date | 2011-01-07 |
Last Update Date | 2011-02-16 |