NPI | 1679041008 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 104290) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02729500) |
Enumeration Date | 2018-11-03 |
Last Update Date | 2019-10-01 |