NPI | 1295175859 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 62451) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 62451) |
Enumeration Date | 2013-06-27 |
Last Update Date | 2023-06-06 |