NPI | 1407296346 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CO DEN.00204604) |
Additional Taxonomies | 122300000X Dentist (Licence: FL DN20146) |
Enumeration Date | 2013-06-25 |
Last Update Date | 2022-08-02 |