NPI | 1932267390 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: CA 109702) |
Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MA 19621) |
Enumeration Date | 2006-12-05 |
Last Update Date | 2023-12-28 |