NPI | 1679531826 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 60371) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D-3846) |
Enumeration Date | 2006-05-03 |
Last Update Date | 2024-05-08 |