NPI | 1659553980 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 8513) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 47392) |
Enumeration Date | 2007-11-28 |
Last Update Date | 2020-09-15 |