NPI | 1225708811 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: CA 106902) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 106902) |
Enumeration Date | 2021-09-15 |
Last Update Date | 2022-02-11 |