NPI | 1972855658 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: CA 61481) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 61481) |
Enumeration Date | 2012-10-05 |
Last Update Date | 2018-03-17 |