NPI | 1891142055 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 64494) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 64494) |
Enumeration Date | 2016-05-18 |
Last Update Date | 2025-07-30 |