NPI | 1770700098 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 45156) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 45156) |
261QD0000X Clinic/Center, Dental (Licence: CA 45156) | |
Enumeration Date | 2007-04-19 |
Last Update Date | 2021-12-23 |