NPI | 1508451485 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: CA 105728) |
Additional Taxonomies | 122300000X Dentist (Licence: FL 25634) |
122300000X Dentist (Licence: SC 8727) | |
Enumeration Date | 2021-03-03 |
Last Update Date | 2022-09-19 |