NPI | 1851767065 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 105676) |
Additional Taxonomies | 122300000X Dentist (Licence: NC 151064) |
1223P0300X Dentist, Periodontics (Licence: MO 202102186) | |
Enumeration Date | 2015-08-12 |
Last Update Date | 2021-07-22 |