NPI | 1255741393 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: CA 100528) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 9823) |
Enumeration Date | 2014-04-29 |
Last Update Date | 2022-02-10 |