NPI | 1972576130 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 45252) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 45252) |
Enumeration Date | 2006-02-08 |
Last Update Date | 2018-10-18 |