NPI | 1508604166 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 110322) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS044763) |
Enumeration Date | 2024-07-17 |
Last Update Date | 2024-07-19 |