NPI | 1710274204 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: CA 61686) |
Additional Taxonomies | 122300000X Dentist (Licence: PA DS038241) |
122300000X Dentist (Licence: NV 7024) | |
Enumeration Date | 2011-07-05 |
Last Update Date | 2024-11-21 |