NPI | 1083195085 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 103982) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 34568) |
Enumeration Date | 2018-08-27 |
Last Update Date | 2022-04-14 |