NPI | 1972735660 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 58300) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 58300) |
Enumeration Date | 2009-08-14 |
Last Update Date | 2016-06-06 |