NPI | 1154334480 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: CA 62278) |
Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MI 014333) |
Enumeration Date | 2006-08-15 |
Last Update Date | 2023-03-07 |