NPI | 1225606072 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: PA DS043185) |
Additional Taxonomies | 122300000X Dentist (Licence: CA DDS106996) |
Enumeration Date | 2021-06-16 |
Last Update Date | 2022-05-08 |