NPI | 1568917110 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA DDS100474) |
Additional Taxonomies | 122300000X Dentist (Licence: CA DDS100474) |
Enumeration Date | 2016-08-23 |
Last Update Date | 2021-04-14 |