NPI | 1538189683 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 34440) |
Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: CA 34440) |
Enumeration Date | 2006-07-20 |
Last Update Date | 2023-03-03 |