NPI | 1912244864 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 62116) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 62116) |
Enumeration Date | 2013-01-12 |
Last Update Date | 2022-08-11 |