NPI | 1215272109 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 61625) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 61625) |
Enumeration Date | 2012-12-03 |
Last Update Date | 2023-03-07 |