NPI | 1225738941 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 110374) |
Additional Taxonomies | 122300000X Dentist (Licence: MA DN1860014) |
Enumeration Date | 2023-03-09 |
Last Update Date | 2024-08-01 |