NPI | 1669626511 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: CA 62932) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 62932) |
122300000X Dentist (Licence: NY 054219-1) | |
Enumeration Date | 2008-11-05 |
Last Update Date | 2021-03-05 |