NPI | 1861957672 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: CA DDS104762) |
Additional Taxonomies | 122300000X Dentist (Licence: VT 016.0133877) |
Enumeration Date | 2019-02-06 |
Last Update Date | 2022-01-28 |