NPI | 1306487160 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00205235) |
Additional Taxonomies | 122300000X Dentist (Licence: NJ 22dI02822400) |
Enumeration Date | 2019-10-03 |
Last Update Date | 2024-10-30 |