NPI | 1881733947 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 28943) |
Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: CA 28943) |
Enumeration Date | 2007-02-05 |
Last Update Date | 2008-07-15 |