NPI | 1891845236 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: CA 52369) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 52369) |
Enumeration Date | 2007-01-10 |
Last Update Date | 2013-12-02 |