NPI | 1629478755 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 103224) |
Additional Taxonomies | 122300000X Dentist (Licence: TX 30404) |
Enumeration Date | 2014-08-26 |
Last Update Date | 2024-04-18 |