NPI | 1578656807 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 48777) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 48777) |
Enumeration Date | 2006-09-30 |
Last Update Date | 2021-04-29 |