NPI | 1558148965 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: GA DN123545) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 109267) |
Enumeration Date | 2023-09-11 |
Last Update Date | 2024-08-01 |