NPI | 1932181674 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: UT 9257847-9921) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 34706) |
Enumeration Date | 2005-11-17 |
Last Update Date | 2023-06-30 |