NPI | 1639198021 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: CA 102278) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D7534) |
Enumeration Date | 2006-07-18 |
Last Update Date | 2022-09-01 |