NPI | 1336681576 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 101024) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 101024) |
Enumeration Date | 2016-11-04 |
Last Update Date | 2023-06-19 |