NPI | 1366813362 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: NV 6732) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 65194) |
122300000X Dentist (Licence: OK 6988) | |
Enumeration Date | 2015-10-15 |
Last Update Date | 2021-09-10 |