NPI | 1417487513 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CA 106157) |
Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: WV 4269) |
Enumeration Date | 2017-06-13 |
Last Update Date | 2022-06-28 |