NPI | 1508419797 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA DDS107368) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1858442) |
1223P0300X Dentist, Periodontics (Licence: MA DN1858442) | |
Enumeration Date | 2019-07-17 |
Last Update Date | 2022-08-09 |