NPI | 1306229893 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CO DR.0063630) |
Additional Taxonomies | 122300000X Dentist (Licence: OH 30.024543) |
1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CO DEN.00204273) | |
Enumeration Date | 2015-07-02 |
Last Update Date | 2021-01-04 |