NPI | 1538790944 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: CA DDS106906) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO DEN.00204261) |
Enumeration Date | 2020-02-04 |
Last Update Date | 2021-10-12 |