NPI | 1992034086 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 53882) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 7718) |
Enumeration Date | 2009-12-18 |
Last Update Date | 2025-09-03 |