NPI | 1477524643 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO 00201885) |
Additional Taxonomies | 122300000X Dentist (Licence: OR d8112) |
Enumeration Date | 2006-01-27 |
Last Update Date | 2024-05-24 |