NPI | 1073916789 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: CA 100212) |
Additional Taxonomies | 122300000X Dentist (Licence: IL 019.030065) |
Enumeration Date | 2014-10-08 |
Last Update Date | 2024-03-13 |