NPI | 1154815058 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 00204172) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 34001) |
Enumeration Date | 2018-06-14 |
Last Update Date | 2021-09-14 |