NPI | 1598077851 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 60054) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE 60128317) |
Enumeration Date | 2010-07-02 |
Last Update Date | 2021-10-04 |