NPI | 1528705993 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 108822) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN D14747) |
Enumeration Date | 2022-05-17 |
Last Update Date | 2024-05-24 |