NPI | 1316599855 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA DDS108965) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D010381) |
Enumeration Date | 2019-07-15 |
Last Update Date | 2023-10-25 |