NPI | 1386167377 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: MD 18432) |
Additional Taxonomies | 122300000X Dentist (Licence: CO DEN.00205436) |
1223G0001X Dentist, General Practice (Licence: MN 13894) | |
Enumeration Date | 2017-07-20 |
Last Update Date | 2024-11-26 |