NPI | 1114136231 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 24207) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 24207) |
Enumeration Date | 2007-05-22 |
Last Update Date | 2024-07-08 |