NPI | 1093372591 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 102703) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1858383) |
Enumeration Date | 2019-05-21 |
Last Update Date | 2020-12-24 |