NPI | 1942477930 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 56712) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 56712) |
122300000X Dentist (Licence: TX 26280) | |
Enumeration Date | 2008-05-09 |
Last Update Date | 2024-05-22 |