NPI | 1720540818 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D11588) |
Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: CA 105104) |
Enumeration Date | 2019-04-05 |
Last Update Date | 2022-09-16 |