NPI | 1265780175 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 61834) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 61834) |
Enumeration Date | 2012-08-27 |
Last Update Date | 2023-05-15 |