NPI | 1740619212 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 64460) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 29385) |
Enumeration Date | 2013-11-05 |
Last Update Date | 2021-03-11 |