NPI | 1831710904 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 106036) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 106036) |
Enumeration Date | 2020-04-30 |
Last Update Date | 2024-08-29 |