NPI | 1861702557 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: CA DDS101101) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE60189165) |
Enumeration Date | 2010-10-14 |
Last Update Date | 2023-08-07 |