NPI | 1225496771 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA DDS30334) |
Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: CA 30334) |
Enumeration Date | 2016-01-28 |
Last Update Date | 2023-10-18 |