NPI | 1376218065 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 108456) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: HI DT-2934) |
Enumeration Date | 2021-08-13 |
Last Update Date | 2023-01-06 |