NPI | 1124294673 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 101992) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 4070) |
Enumeration Date | 2008-05-05 |
Last Update Date | 2022-03-25 |