NPI | 1306573183 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 107714) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 107714) |
Enumeration Date | 2022-08-02 |
Last Update Date | 2023-06-06 |