NPI | 1972884328 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 21246) |
Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 21246) |
Enumeration Date | 2011-08-30 |
Last Update Date | 2011-08-30 |