NPI | 1396345963 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: NM DB-2023-0092) |
Additional Taxonomies | 122300000X Dentist (Licence: CO DEN.00204532) |
1223G0001X Dentist, General Practice (Licence: NV 7425T) | |
Enumeration Date | 2020-10-31 |
Last Update Date | 2023-10-01 |