NPI | 1164587796 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 8017575-9922) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 30711) |
Enumeration Date | 2006-12-26 |
Last Update Date | 2021-11-24 |