NPI | 1730149840 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 103569) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 22541) |
1223D0001X Dentist, Dental Public Health (Licence: OH 21650) | |
Enumeration Date | 2006-03-23 |
Last Update Date | 2019-05-29 |