NPI | 1215908116 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 60600) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 5142466-9921) |
Enumeration Date | 2006-01-30 |
Last Update Date | 2022-08-01 |