NPI | 1932548591 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA DDS38213) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 38213) |
Enumeration Date | 2013-06-17 |
Last Update Date | 2019-10-29 |