NPI | 1972743458 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 35433) |
Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: CA 35433) |
1223G0001X Dentist, General Practice (Licence: NV 3783) | |
Enumeration Date | 2009-02-24 |
Last Update Date | 2024-05-17 |