NPI | 1780242784 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 104843) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12013187A) |
Enumeration Date | 2019-06-04 |
Last Update Date | 2020-04-22 |