NPI | 1730660929 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 103196) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 10148) |
Enumeration Date | 2018-08-24 |
Last Update Date | 2018-12-05 |