NPI | 1003266164 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00203512) |
Additional Taxonomies | 122300000X Dentist (Licence: NM DD4531) |
Enumeration Date | 2016-06-20 |
Last Update Date | 2019-06-13 |