NPI | 1306907530 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN-10669) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 049231-1) |
1223G0001X Dentist, General Practice (Licence: CT 008886) | |
Enumeration Date | 2006-12-12 |
Last Update Date | 2023-02-13 |