NPI | 1952479925 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: CA 58976) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 6055) |
Enumeration Date | 2006-11-30 |
Last Update Date | 2018-07-25 |