NPI | 1700272663 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60749890) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
1223G0001X Dentist, General Practice (Licence: CA DDS100564) | |
Enumeration Date | 2015-04-07 |
Last Update Date | 2021-10-28 |