NPI | 1992251516 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: CA 102464) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2016-09-01 |
Last Update Date | 2021-10-06 |