NPI | 1154798320 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 103772) |
Additional Taxonomies | 122300000X Dentist (Licence: ID D-4678) |
Enumeration Date | 2015-08-24 |
Last Update Date | 2022-01-04 |