NPI | 1720716350 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: CA DDS109764) |
Additional Taxonomies | 122300000X Dentist (Licence: GA DN122699) |
Enumeration Date | 2022-08-11 |
Last Update Date | 2024-05-24 |