NPI | 1124431200 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: NV 6504) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 64416) |
1223E0200X Dentist, Endodontics (Licence: NV 6504) | |
1223P0300X Dentist, Periodontics (Licence: NV 6504) | |
1223P0700X Dentist, Prosthodontics (Licence: NV 6504) | |
1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NV 6504) | |
Enumeration Date | 2014-06-06 |
Last Update Date | 2023-06-12 |