NPI | 1871955336 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA DDS100287) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD4470) |
Enumeration Date | 2016-03-24 |
Last Update Date | 2017-02-09 |