NPI | 1093238610 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: CO 00205471) |
Additional Taxonomies | 122300000X Dentist (Licence: NM DB-2025-0154) |
122300000X Dentist (Licence: FL DN29562) | |
122300000X Dentist (Licence: CA 101669) | |
122300000X Dentist (Licence: TX 41168) | |
Enumeration Date | 2017-07-25 |
Last Update Date | 2025-08-22 |