NPI | 1497001770 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 101274) |
Additional Taxonomies | 122300000X Dentist (Licence: TN 9539) |
Enumeration Date | 2012-07-24 |
Last Update Date | 2021-12-13 |