NPI | 1881742526 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 59926) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 21324) |
Enumeration Date | 2007-01-08 |
Last Update Date | 2010-12-13 |