NPI | 1215237730 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 59839) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 59239) |
Enumeration Date | 2010-11-01 |
Last Update Date | 2022-01-03 |