NPI | 1861575292 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 39112) |
Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: CA 39112) |
Enumeration Date | 2006-10-21 |
Last Update Date | 2007-07-08 |