NPI | 1700368792 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA DDS107422) |
Additional Taxonomies | 122300000X Dentist (Licence: TX 33936) |
Enumeration Date | 2018-09-05 |
Last Update Date | 2023-09-17 |